A Family Navigator Intervention to Improve ADHD- Related Treatment Adherence (I2-ART) for Minority Children

项目摘要/摘要 我是一名发展行为儿科医生，获得了临床研究硕士学位。我的长期目标 是成为一名独立研究人员，专注于促进儿童的发展-行为结果 通过提高儿童对心理健康治疗计划的依从性，来自不同、服务不足的群体的儿童 条件，包括注意力缺陷多动障碍(ADHD)。我目前的目标，代表着 追求这一目标的下一步，是开发一种针对文化定制的家庭导航员干预措施，以改善 针对少数族裔儿童的ADHD相关治疗依从性(I2-ART)使用系统的、以患者为中心的、 迭代方法与行为干预发展的轨道模型一致。关键要素 支持我的长期目标和当前目标的职业发展计划包括：(1) 设计和评估临床和精神卫生服务试验以提高治疗依从性，(2)健康 差异和社区合作研究，以及(3)有效的赠款和手稿写作。我的导师之道 团队包括NIH资助的研究人员，他们在ADHD、临床试验设计、治疗依从性、 健康差距和社区伙伴关系研究。此外，辛辛那提儿童医院 在NIH资助的美国儿童医院中排名第二，提供了出色的研究环境和 对初级教员的大力支持，包括30名目前获得NIH职业发展奖的人。 建议研究：ADHD是最常见的儿童神经发育障碍，与 严重的长期损害。目前的指南建议使用兴奋剂药物和/或行为 将治疗作为ADHD的一线治疗。尽管有证据表明持续的治疗对有效的 管理ADHD症状，治疗依从性仍然不是最优的，尤其是在 少数族裔儿童。多动症治疗中种族/民族差异的假设原因包括不确定性 关于药物疗效和副作用，对医疗保健系统的不信任，以及获得精神卫生服务的机会减少 医疗服务。本研究旨在开发和测试I2-ART干预措施，以提高患者的治疗依从性 患有ADHD的少数族裔(拉丁裔和非裔美国人)儿童。拟议的研究涉及三个轨道阶段： 在阶段1a期间，我们将与主要利益相关者(即护理者、临床医生和家庭)一起开展重点小组 导航员，n=24)，以确定和发展I2-ART的基本要素。接下来，在1b阶段，我们将培训四名 家庭导航员与治疗照顾者一起实施I2-ART-患有ADHD的天真儿童(n=8-12)依次 以确定可行性和可接受性。在第二阶段，我们将使用1b阶段的调查结果将I2-ART修改为 需要，然后将评估修订后的I2-ART(n=40)的初步疗效，与通常的 对照条件(n=20)，对ADHD治疗依从性。在调查期间收集的初步数据 拟议的研究将通知随后的R01随机对照试验，以检查I2-ART的疗效。

PROJECT SUMMARY/ABSTRACT I am a developmental-behavioral pediatrician who has earned an MS in Clinical Research. My long-term goal is to become an independent researcher focused on advancing developmental-behavioral outcomes of children from diverse, underserved groups by improving their adherence to treatment plans for mental health conditions, including attention-deficit hyperactivity disorder (ADHD). My current objective, which represents the next step in pursuit of this goal, is to develop a culturally-tailored family navigator Intervention to Improve ADHD-Related Treatment adherence (I2-ART) for minority children using a systematic, patient-centered, iterative approach consistent with the ORBIT model for behavioral intervention development. Key elements of the career development plan to support both my long-term goal and current objective include training in (1) the design and evaluation of clinical and mental health services trials to improve treatment adherence, (2) health disparities and community-partnered research, and (3) effective grant and manuscript writing. My mentorship team includes NIH-funded investigators with expertise in ADHD, clinical trial design, treatment adherence, health disparities, and community-partnership research. Furthermore, Cincinnati Children’s Hospital, which ranks #2 among U.S. children’s hospitals for NIH funding, provides an outstanding research environment and strong support for junior faculty, including >30 current recipients of NIH Career Development Awards. Proposed Research: ADHD is the most common pediatric neurodevelopmental disorder and is associated with significant long-term impairments. Current guidelines recommend stimulant medication and/or behavioral therapy as first-line treatments for ADHD. Despite evidence that consistent treatment is important for effectively managing ADHD symptoms, treatment adherence remains suboptimal and is especially problematic among minority children. Hypothesized reasons for racial/ethnic disparities in ADHD treatment include uncertainties about medication efficacy and side effects, distrust of the health care system, and decreased access to mental health services. This study aims to develop and test the I2-ART intervention to improve treatment adherence in minority (Latinx and African American) children with ADHD. The proposed study involves three ORBIT phases: During phase 1a, we will conduct focus groups with key stakeholders (i.e., caregivers, clinicians, and family navigators, n=24) to identify and develop I2-ART’s basic elements. Next, during phase 1b, we will train four family navigators to implement I2-ART with caregivers of treatment-naïve children with ADHD (n=8-12) in order to determine feasibility and acceptability. In phase 2, we will use phase 1b findings to modify I2-ART as needed, and then will evaluate the preliminary efficacy of the revised I2-ART (n=40), compared to the “usual care” control condition (n=20), on ADHD treatment adherence. The preliminary data collected during the proposed study will inform a subsequent R01 randomized controlled trial to examine I2-ART efficacy.